Healthcare Provider Details

I. General information

NPI: 1598981045
Provider Name (Legal Business Name): PASADENA NYX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W CALIFORNIA BLVD SUITE 514
PASADENA CA
91105-3029
US

IV. Provider business mailing address

16710 NEARVIEW DR
SANTA CLARITA CA
91387-1734
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-9090
  • Fax: 626-795-9605
Mailing address:
  • Phone: 661-424-1247
  • Fax: 661-424-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS CHARLEBOIS
Title or Position: MANAGING PARTNER
Credential:
Phone: 661-424-1247